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The purpose of this study was to describe the recent trends of invasive and noninvasive β-hemolytic Streptococcus cultures in the Veterans’ Affairs (VA) cohort from 2009 to 2018.
Retrospective cohort study from January 1, 2009, to January 1, 2019.
Veterans’ Affairs medical centers.
Patients or participants:
All patients aged 18 years and older with cultures positive for β-hemolytic Streptococcus at a VA facility were included in the study.
Data were retrieved from the VA Corporate Data Warehouse using structure query language through the SQL Server Management Studio software.
Between 2009 and 2018, there were 40,625 patients with cultures with β-hemolytic Streptococcus. The median age was 64 years (interquartile range [IQR], 55–71) and the median Charlson comorbidity index was 4 (IQR, 2–7). Distributions for each type of β-hemolytic Streptococcus based on site of culture are provided. The 30-day all-cause mortality rate from all invasive β-hemolytic Streptococcus cases was 2.3%, and the 90-day all-cause mortality rate was 4.4%. The 30- and 90-day all-cause mortality rates for Streptococcus cases were higher for group A (3.9% and 6.1% respectively) and for groups C and G combined (3.2% and 6.1%, respectively) than for group B (2.0% and 4.0%, respectively).
Trends of cultures for invasive and noninvasive β-hemolytic Streptococcus suggest an association with disease and mortality. The burden associated with β-hemolytic Streptococcus infections should not be underestimated.
This paper characterizes novel “star” defects in GaN films grown with metal–organic vapor phase deposition (MOVPE) on GaN substrates with electron channeling contrast imaging (ECCI) and high-resolution electron backscatter diffraction (HREBSD). These defects are hundreds of microns in size and tend to aggregate threading dislocations at their centers. They are the intersection of six nearly ideal low-angle tilt boundaries composed of $\langle a\rangle$-type pyramidal edge dislocations, each on a unique slip system.
Coronary artery aneurysms in children were observed as a rare complication associated with coronavirus disease 2019 (COVID-19). This case report describes the severe end of the spectrum of the new multisystem inflammatory syndrome in a 12-year-old child with coronary aneurysms, myocardial dysfunction, and shock, managed successfully with extracorporeal membrane oxygenation support and immunomodulation therapy. This report also highlights the additional benefits of cardiac CT in the diagnosis and follow-up of coronary aneurysms.
A field study was conducted in 2017 and 2018 to determine foliar efficacy of halauxifen-methyl, 2,4-D, or dicamba applied alone and in combination with glyphosate at preplant burndown timing. Experiments were conducted near Painter, VA; Rocky Mount, NC; Jackson, NC; and Gates, NC. Control of horseweed, henbit, purple deadnettle, cutleaf evening primrose, curly dock, purple cudweed, and common chickweed were evaluated. Halauxifen-methyl applied at 5 g ae ha−1 controlled small and large horseweed 89% and 79%, respectively, and was similar to control by dicamba applied at 280 g ae ha−1. Both rates of 2,4-D—533 g ae ha−1(low rate [LR]) or 1,066 g ae ha−1 (high rate [HR])—were less effective than halauxifen-methyl and dicamba for controlling horseweed. Halauxifen-methyl was the only auxin herbicide to control henbit (90%) and purple deadnettle (99%). Cutleaf evening primrose was controlled 74% to 85%, 51%, and 4% by 2,4-D, dicamba, and halauxifen-methyl, respectively. Dicamba and 2,4-D controlled curly dock 59% to 70% and were more effective than halauxifen-methyl (5%). Auxin herbicides applied alone controlled purple cudweed and common chickweed 21% or less. With the exception of cutleaf evening primrose (35%) and curly dock (37%), glyphosate alone provided 95% or greater control of all weeds evaluated. These experiments demonstrate halauxifen-methyl effectively (≥79%) controls horseweed, henbit, and purple deadnettle, whereas common chickweed, curly dock, cutleaf evening primrose, and purple cudweed control by the herbicide is inadequate (≤7%).
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
Athletic competition played an important role in ancient Greek and Roman culture. From the earliest days, competitive athletics included the combat sports of boxing, wrestling and pankration. Though athletic combat sports continued during the Roman period along with the increase in agonistic festivals and retained their popularity and importance, the spectacle of gladiatorial combat itself also spread throughout the Roman Empire, including the Greek eastern sections. Combat sports presented the spectator with extreme acts of violence which were potentially even fatal. But that violence was controlled and purposive. It took place in ceremonial contexts – funerals, or religious festivals primarily – with athletes wearing special uniforms: nudity in the case of combat athletes and identifiable armaments for gladiators. The fights were not violent chaos or murderous free-for-alls, but regulated and controlled by rules and expectations, all monitored by referees and the watching people themselves. These games were able to give visible expression to the values and ideology at the heart of Greek and Roman societies: courage, skill and discipline, perseverance to victory against all adversity and at all costs, even one’s life, and the ostentatious demonstration of personal excellence. The public nature of the performances is critical: it must be seen to be legitimised. Victory in such combat was worthy of immortality.
Rapeseed is a popular cover crop choice due to its deep-growing taproot, which creates soil macropores and increases water infiltration. Brassicaceae spp. that are mature or at later growth stages can be troublesome to control. Experiments were conducted in Delaware and Virginia to evaluate herbicides for terminating rapeseed cover crops. Two separate experiments, adjacent to each other, were established to evaluate rapeseed termination by 14 herbicide treatments at two timings. Termination timings included an early and late termination to simulate rapeseed termination prior to planting corn and soybean, respectively, for the region. At three locations where rapeseed height averaged 12 cm at early termination and 52 cm at late termination, glyphosate + 2,4-D was most effective, controlling rapeseed 96% 28 d after early termination (DAET). Paraquat + atrazine + mesotrione (92%), glyphosate + saflufenacil (91%), glyphosate + dicamba (91%), and glyphosate (86%) all provided at least 80% control 28 DAET. Rapeseed biomass followed a similar trend. Paraquat + 2,4-D (85%), glyphosate + 2,4-D (82%), and paraquat + atrazine + mesotrione (81%) were the only treatments that provided at least 80% control 28 d after late termination (DALT). Herbicide efficacy was less at Painter in 2017, where rapeseed height was 41 cm at early termination, and 107 cm at late termination. No herbicide treatments controlled rapeseed >80% 28 DAET or 28 DALT at this location. Herbicide termination of rapeseed is best when the plant is small; termination of large rapeseed plants may require mechanical of other methods beyond herbicides.
Residual herbicides are routinely applied to control troublesome weeds in pumpkin production. Fluridone and acetochlor, Groups 12 and 15 herbicides, respectively, provide broad-spectrum PRE weed control. Field research was conducted in Virginia and New Jersey to evaluate pumpkin tolerance and weed control to PRE herbicides. Treatments consisted of fomesafen at two rates, ethalfluralin, clomazone, halosulfuron, fluridone, S-metolachlor, acetochlor emulsifiable concentrate (EC), acetochlor microencapsulated (ME), and no herbicide. At one site, fluridone, acetochlor EC, acetochlor ME, and halosulfuron injured pumpkin 81%, 39%, 34%, and 35%, respectively, at 14 d after planting (DAP); crop injury at the second site was 40%, 8%, 19%, and 33%, respectively. Differences in injury between the two sites may have been due to the amount and timing of rainfall after herbicides were applied. Fluridone provided 91% control of ivyleaf morningglory and 100% control of common ragweed at 28 DAP. Acetochlor EC controlled redroot pigweed 100%. Pumpkin treated with S-metolachlor produced the most yield (10,764 fruits ha–1) despite broadcasting over the planted row; labeling requires a directed application to row-middles. A separate study specifically evaluated fluridone applied PRE at 42, 84, 126, 168, 252, 336, and 672 g ai ha–1. Fluridone resulted in pumpkin injury ≥95% when applied at rates of ≥168 g ai ha–1; significant yield loss was noted when the herbicide was applied at rates >42 g ai ha–1. We concluded that fluridone and acetochlor formulations are unacceptable candidates for pumpkin production.
Auxin herbicides are used in combinations to control glyphosate-resistant horseweed preplant burndown. Herbicide labels for 2,4-D–containing products require a 30-d rotation interval for planting cotton cultivars not resistant to 2,4-D. Dicamba labels require an accumulation of 2.5 cm of rain plus 21 d per 280 g ae ha–1 rotation interval for planting cotton cultivars not resistant to dicamba. Previous research has shown that cotton injury caused by dicamba applied 14 d before planting was transient with little effect on cotton yield, whereas 2,4-D has little effect on cotton when applied 7 d prior to planting. Injury caused by dicamba and 2,4-D is inversely related to rainfall received between herbicide application and cotton planting. Experiments were conducted to evaluate cotton tolerance to halauxifen-methyl, a new Group 4 herbicide, applied at intervals shorter than labeled requirements. Experiments were established near Painter and Suffolk, VA, and Belvidere, Clayton, Eure, Lewiston, and Rocky Mount, NC, during the 2017 and 2018 growing seasons. Herbicide treatments included halauxifen, dicamba, and 2,4-D applied 4, 3, 2, 1, and 0 wk before planting (WBP). Visible estimates of cotton growth reduction and total injury were collected 1, 2, and 4 wk after cotton emergence (WAE). Cotton stand and percentage of plants with distorted leaves were recorded 2 and 4 WAE. Cotton plant heights were recorded 4 and 8 WAE. Halauxifen was less injurious (9%) than dicamba (26%) or 2,4-D (21%) 2 WAE when herbicides were applied 0 WBP. Cotton stand reduction 2 WAE by halauxifen was less than 2,4-D and dicamba when applied 0 WBP. Injury observed from herbicides applied 1, 2, 3, and 4 WBP was minor, and no significant differences in cotton stand were observed. Early-season cotton injury was transient, and seed cotton yield was unaffected by any treatment.
To integrate electronic clinical decision support tools into clinical practice and to evaluate the impact on indwelling urinary catheter (IUC) use and catheter-associated urinary tract infections (CAUTIs).
Design, Setting, and Participants
This 4-phase observational study included all inpatients at a multicampus, academic medical center between 2011 and 2015.
Phase 1 comprised best practices training and standardization of electronic documentation. Phase 2 comprised real-time electronic tracking of IUC duration. In phase 3, a triggered alert reminded clinicians of IUC duration. In phase 4, a new IUC order (1) introduced automated order expiration and (2) required consideration of alternatives and selection of an appropriate indication.
Overall, 2,121 CAUTIs, 179,070 new catheters, 643,055 catheter days, and 2,186 reinsertions occurred in 3·85 million hospitalized patient days during the study period. The CAUTI rate per 10,000 patient days decreased incrementally in each phase from 9·06 in phase 1 to 1·65 in phase 4 (relative risk [RR], 0·182; 95% confidence interval [CI], 0·153–0·216; P<·001). New catheters per 1,000 patient days declined from 53·4 in phase 1 to 39·5 in phase 4 (RR, 0·740; 95% CI, 0·730; P<·001), and catheter days per 1,000 patient days decreased from 194·5 in phase 1 to 140·7 in phase 4 (RR, 0·723; 95% CI, 0·719–0·728; P<·001). The reinsertion rate declined from 3·66% in phase 1 to 3·25% in phase 4 (RR, 0·894; 95% CI, 0·834–0·959; P=·0017).
The phased introduction of decision support tools was associated with progressive declines in new catheters, total catheter days, and CAUTIs. Clinical decision support tools offer a viable and scalable intervention to target hospital-wide IUC use and hold promise for other quality improvement initiatives.
Few trials have compared psychosocial therapies for people with bipolar affective disorder, and conventional meta-analyses provided limited comparisons between therapies.
To combine evidence for the efficacy of psychosocial interventions used as adjunctive treatment of bipolar disorder in adults, using network meta-analysis (NMA).
Systematic review identified studies and NMA was used to pool data on relapse to mania or depression, medication adherence, and symptom scales for mania, depression and Global Assessment of Functioning (GAF).
Carer-focused interventions significantly reduced the risk of depressive or manic relapse. Psychoeducation alone and in combination with cognitive–behavioural therapy (CBT) significantly reduced medication non-adherence. Psychoeducation plus CBT significantly reduced manic symptoms and increased GAF. No intervention was associated with a significant reduction in depression symptom scale scores.
Only interventions for family members affected relapse rates. Psychoeducation plus CBT reduced medication non-adherence, improved mania symptoms and GAF. Novel methods for addressing depressive symptoms are required.
The effective design and implementation of interventions that reduce vulnerability and poverty require a solid understanding of underlying poverty dynamics and associated behavioral responses. Stochastic and dynamic benefit streams can make it difficult for the poor to learn the value of such interventions to them. We explore how dynamic field experiments can help (i) intended beneficiaries to learn and understand these complicated benefit streams, and (ii) researchers to better understand how the poor respond to risk when faced with nonlinear welfare dynamics. We discuss and analyze dynamic risk valuation experiments in Morocco, Peru, and Kenya.
Our knowledge of the universe comes from recording the photon and particle fluxes incident on the Earth from space. We thus require sensitive measurement across the entire energy spectrum, using large telescopes with efficient instrumentation located on superb sites. Technological advances and engineering constraints are nearing the point where we are recording as many photons arriving at a site as is possible. Major advances in the future will come from improving the quality of the site. The ultimate site is, of course, beyond the Earth’s atmosphere, such as on the Moon, but economic limitations prevent our exploiting this avenue to the degree that the scientific community desires. Here we describe an alternative, which offers many of the advantages of space for a fraction of the cost: the Antarctic Plateau.
The most important factor controlling the timing of Phanerozoic mineralogical evolution in the Bivalvia appears to be thermal potentiation of calcite deposition in colder marine and estuarine environments. Cold temperature has promoted mineralogical evolution in the Bivalvia by kinetically facilitating (potentiating) initially weak biological controls for calcite, thereby exposing their genetic basis to natural selection. Calcite has evolved in bivalve shells for a variety of selective advantages, including resistance to dissolution; resistance to chemical boring by algae and gastropods; reduced shell density in swimming and soft-bottom reclining species; enhanced flexibility in simple prismatic shell layers; and fracture localization and economy of secretion in association with certain foliated structures.
Endogenous calcite in bivalve shells varies from biologically induced to weakly and strongly biologically controlled. Biologically controlled calcite generally first appears in bivalve shells as an impersistent component of the outer shell layer, only later, in some groups, expanding to include the entire outer and then part or all of the middle and inner shell layers. The initial stages of mineralogical evolution are shown by certain modern Mytilidae, Veneridae and Petricolidae. In the latter two families, the calcite occurs as conellae in the outer part of the outer shell layer. Calcitic conellae in the inner shell layer of Pliocene Mercenaria are not barnacle plates, as previously indicated, but endogenous calcite comparable in origin to other venerid conellae. Their occurrence in Mercenaria may reflect thermal potentiation of weak biological controls for calcite, as well as local detachment of the secretory mantle epithelium near the pallial and adductor musculature.